Could Deadly Madagascar Plague Outbreak Spread To The United States? Experts Weigh In On Fears

Since August, over 2,000 people in the African island nation of Madagascar have become infected with the plague – the very same deadly disease that decimated Europe and killed 50 million people during the so-called “Black Death.” Of those infected, 165 have already died. What’s worse, the vast majority of plague cases in Madagascar this year have been of the deadlier pneumonic variety, which spreads via coughing, spitting and/or sneezing and is almost 100 percent fatal if untreated. Traditional bubonic plague is spread through the bites of fleas which have bitten plague-infected rats.

While plague is endemic to Madagascar, with a “plague season” happening annually, this year’s outbreak has been called “historic,” and the worst to hit the region in at least 50 years. As Metro reports, the 2017 Madagascar plague outbreak has already spread to over half of the island nation (reaching at least 14 of the country’s 22 regions), and while cases are beginning to taper off, there are widespread fears that the deadly disease could cross waters and borders and perhaps even continental divides.

Traditionally, plague in Madagascar sticks to rural areas and infects roughly 400 people annually. This year, the infection has set its sights on Madagascar’s two largest cities, Antananarivo and Toamasina, and already resulted in an infection rate five times the annual average – despite the fact that “plague season” won’t end until April 2018.

Despite the decline in new plague cases in Madagascar, CNN reports that widespread fears that the potentially devastating disease could go global have prompted a response from the World Health Organization (WHO). While pneumonic plague is particularly deadly and making up the majority of this year’s plague cases, the disease has a relatively short incubation period. WHO experts believe that airport screenings for potentially ill travelers make the possibility of pneumonic plague “escaping” Madagascar low. According to the WHO, the risk of additional plague outbreaks in Madagascar remains high, but the chance of the disease spreading globally is “low.”

“While the number of new cases and hospitalizations due to plague is declining in Madagascar, WHO cannot rule out the possibility of flare ups of additional cases until the typical plague season ends in April 2018, and thus recommends maintaining vigilance until then. Based on available information and response measures implemented to date, the potential risk of further spread of plague at national level remains high. The risk of international spread is mitigated by the short incubation period of pneumonic plague, implementation of exit screening measures and advice to travelers to Madagascar, and scaling up of preparedness and operational readiness activities in neighbouring Indian Ocean islands and other southern and east African countries. The overall global risk is considered to be low.”

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While the risk of plague spreading outside of Africa has been deemed low by the WHO, Madagascar’s nine closest neighboring countries remain on high alert and are standing by in readiness should the much-feared “Black Death” pop up inside their borders. Those nine nations include Comoros, Ethiopia, Kenya, Mauritius, Mozambique, Réunion island, Seychelles, South Africa, and Tanzania, and have been deemed “priority countries” due to their high levels of trade and travel with Madagascar.

According to scientists, this year’s highly virulent spread of pneumonic plague can be traced to a single infected individual who infected others while traveling to find medical care early on in the Madagascar plague season. That, coupled with a plague season that began three months earlier than average and widespread infection in heavily populated cities, have contributed to this year’s historic outbreak.

While no travel or trade restrictions between Madagascar and the international community have been officially advised, international travelers and those working in the country have been warned of the increased risk of infection while in the country, as well as the possibility of being detained due to implementation of exit screening measures of those infected individuals attempting to leave the nation.

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Dilys Morgan, head of emerging infections and zoonoses at Public Health England, has also attempted to curtail public fears with a statement reminding people that plague is much more treatable than it was when it devastated Europe centuries ago. Early detection and treatment with antibiotics can and do save lives and with treatment plague survival rates are very good – even in cases of pneumonic plague.

“It is important that travelers to Madagascar seek advice before traveling and are aware of the measures they can take to reduce the risk of infection. Plague is no longer the threat to humans that it was centuries ago, as antibiotics work well if treatment is started early.”